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Diotaiuti P, Valente G, Corrado S, Tosti B, Carissimo C, Di Libero T, Cerro G, Rodio A, Mancone S. Enhancing Working Memory and Reducing Anxiety in University Students: A Neurofeedback Approach. Brain Sci 2024; 14:578. [PMID: 38928578 PMCID: PMC11202122 DOI: 10.3390/brainsci14060578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: Neurofeedback training (NFT) has emerged as a promising approach for enhancing cognitive functions and reducing anxiety, yet its specific impact on university student populations requires further investigation. This study aims to examine the effects of NFT on working memory improvement and anxiety reduction within this demographic. (2) Methods: A total of forty healthy university student volunteers were randomized into two groups: an experimental group that received NFT and a control group. The NFT protocol was administered using a 14-channel Emotiv Epoc X headset (EMOTIV, Inc., San Francisco, CA 94102, USA) and BrainViz software version Brain Visualizer 1.1 (EMOTIV, Inc., San Francisco, CA 94102, USA), focusing on the alpha frequency band to target improvements in working memory and reductions in anxiety. Assessment tools, including the Corsi Block and Memory Span tests for working memory and the State-Trait Anxiety Inventory-2 (STAI-2) for anxiety, were applied pre- and post-intervention. (3) Results: The findings indicated an increase in alpha wave amplitude in the experimental group from the second day of NFT, with statistically significant differences observed on days 2 (p < 0.05) and 8 (p < 0.01). Contrary to expectations based on the previous literature, the study did not observe a concurrent positive impact on working memory. Nonetheless, a significant reduction in state anxiety levels was recorded in the experimental group (p < 0.001), corroborating NFT's potential for anxiety management. (4) Conclusions: While these results suggest some potential of the technique in enhancing neural efficiency, the variability across different days highlights the need for further investigation to fully ascertain its effectiveness. The study confirms the beneficial impact of NFT on reducing state anxiety among university students, underscoring its value in psychological and cognitive performance enhancement. Despite the lack of observed improvements in working memory, these results highlight the need for continued exploration of NFT applications across different populations and settings, emphasizing its potential utility in educational and therapeutic contexts.
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Affiliation(s)
- Pierluigi Diotaiuti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
| | - Giuseppe Valente
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
| | - Stefano Corrado
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
| | - Beatrice Tosti
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
| | - Chiara Carissimo
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (C.C.); (G.C.)
| | - Tommaso Di Libero
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
| | - Gianni Cerro
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (C.C.); (G.C.)
| | - Angelo Rodio
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
| | - Stefania Mancone
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy; (G.V.); (S.C.); (B.T.); (T.D.L.); (A.R.); (S.M.)
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Boerner KE, Keogh E, Inkster AM, Nahman-Averbuch H, Oberlander TF. A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar. Neurosci Biobehav Rev 2024; 158:105546. [PMID: 38272336 DOI: 10.1016/j.neubiorev.2024.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.
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Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amy M Inkster
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Asefi Rad A, Wippert PM. Insights into pain distraction and the impact of pain catastrophizing on pain perception during different types of distraction tasks. FRONTIERS IN PAIN RESEARCH 2024; 5:1266974. [PMID: 38322588 PMCID: PMC10844527 DOI: 10.3389/fpain.2024.1266974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction Distraction is commonly used to reduce pain, but the effectiveness of distractions remains inconclusive. Studies have shown that pain catastrophizing could modulate the effectiveness of distraction strategies. The present study aimed to compare various distraction tasks, then control for pain catastrophizing, and examine how this relationship varies with pain intensity and unpleasantness across different distraction tasks. Methods Forty-one pain-free participants (aged 27.00 ± 5.41) were recruited for a cross-sectional study. Four types of distraction (cognitive, sensory, emotional, and social) were presented, while moderate pain intensity was induced by electrical stimulation. Before starting the experiment, moderate pain intensity was individually calibrated as six on the Numerical Pain Rating Scale (NRS) to control individual differences in pain sensitivity. Each participant performed all four distraction tasks in a random order. NRS measured pain assessment. Pain catastrophizing was measured by the Pain Catastrophizing Scale (PCS). A repeated measure ANCOVA was conducted to examine the effects of pain dimensions during distraction tasks as a within-subject and pain catastrophizing as a covariate factor. Results A significant difference was observed in the pain intensity and unpleasantness during cognitive distraction. After controlling for PCS, there were diverse associations between PCS and pain intensity across distinct distraction tasks: social vs. sensory, and cognitive vs. sensory distraction. A consistent pattern in pain unpleasantness emerged with minor variations. This interaction underscored notable distinctions between social vs. sensory and emotional distractions, as well as between cognitive vs. sensory and emotional distractions. However, only the correlation in social distraction remained significant in both pain dimensions. Discussion Our findings reveal that the link between PCS and pain dimensions varies across different distraction tasks, suggesting diverse interactions. Particularly, social distraction, characterized by both emotional and cognitive states, proves beneficial with lower PCS scores; however, this advantage diminishes as PCS scores increase.
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Affiliation(s)
- Arash Asefi Rad
- Medical Sociology and Psychobiology, Department of Health and Physical Activity, University of Potsdam, Potsdam, Germany
| | - Pia-Maria Wippert
- Medical Sociology and Psychobiology, Department of Health and Physical Activity, University of Potsdam, Potsdam, Germany
- Faculty of Health Sciences, Joint Faculty of the University of Potsdam, Brandenburg Medical School Theodor Fontane, and the Brandenburg University of Technology Cottbus-Senftenberg, Postdam, Germany
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Kreddig N, Hasenbring MI, Keogh E. Comparing the Effects of Thought Suppression and Focused Distraction on Pain-Related Attentional Biases in Men and Women. THE JOURNAL OF PAIN 2022; 23:1958-1972. [PMID: 35914643 DOI: 10.1016/j.jpain.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Increasing attentional focus away from pain can affect pain experience, suggesting that cognitive strategies that move attentional allocation may be a moderator of pain. In a pre-post-design, the present study examined the effects of 2 cognitive strategies used in pain contexts, thought suppression and focused distraction, on subsequent pain-related attention. Thought suppression was hypothesized to increase pain-related attention, whereas focused distraction was expected to reduce it. Influences of both anxiety and sex were also considered, as secondary questions. 139 (86 women, 53 men) healthy, pain-free participants were randomly assigned to use either thought suppression or focused distraction during a mild cold pressor test (CPT). Pain-related attention was examined using a dot-probe and an attentional blink task, pre-and post-CPT. Questionnaires about relevant cognitive and emotional aspects, demographics, and pain were completed. Results showed no difference in the effect of the 2 pain inhibition strategies on pain-related attention. The hypothesized rebound effect in thought suppression on pain-related attention did not emerge. However, thought suppression showed a short-term benefit in comparison to focused distraction regarding reported pain and perceived threat during the cold pressor test. Few sex differences were found. Thus, the cognitive strategies affected pain outcomes, but did not influence pain-related attention. PERSPECTIVE: Cognitive strategies could help with pain through changing attention allocation. In this study, the effects of the 2 cognitive strategies thought suppression and focused distraction on pain-related attention in men and women were examined. Elucidating mechanisms that lie behind pain strategies that focus on changing attention may help improve treatments.
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Affiliation(s)
- Nina Kreddig
- Ruhr University Bochum, Bochum, Germany; University of Bath, Bath, UK.
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Brown JC, Boat R, Williams NC, Johnson MA, Sharpe GR. The effect of trait self-control on dyspnoea and tolerance to a CO 2 rebreathing challenge in healthy males and females. Physiol Behav 2022; 255:113944. [PMID: 35973643 DOI: 10.1016/j.physbeh.2022.113944] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/28/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND High trait self-control is associated with greater tolerance of unpleasant sensations including effort and pain. Dyspnoea and pain have several commonalities and this study aimed to investigate for the first time whether trait self-control influences responses to a hypercapnic rebreathing challenge designed to induce dyspnoea. As sex also influences tolerance to dyspnoea, we also sought to investigate whether this moderated the role of trait self-control. METHODS Participants (n = 65, 32 females) scoring high or low for trait self-control, performed a standardised rebreathing challenge, in which inspired carbon dioxide (CO2) gradually increased over a period of 6 min or until an intolerable level of dyspnoea. Air hunger (AH) intensity - a distinctive quality of dyspnoea, was measured every 30 s. The multidimensional dyspnoea profile (MDP) was completed after the rebreathing challenge for a more complete overview of breathing discomfort. RESULTS Males high in trait self-control (SCHIGH) (302 ± 42 s), tolerated the rebreathing challenge for longer than males low in self-control (SCLOW) (252 ± 66 s, P = 0.021), experienced slower increases in AH intensity during the rebreathing challenge (0.03 ± 0.01 cm.s - 1 vs. 0.04 ± 0.01 cm.s - 1,P = 0.045) and reported lower perceived mental effort on the MDP (4.94 ± 2.46 vs. 7.06 ± 1.60, P = 0.007). There was no difference between SCHIGH and SCLOW females for challenge duration. However, SCHIGH females (9.29 ± 0.66 cm) reported greater air hunger at the end of the challenge than SCLOW females (7.75 ± 1.75 cm, P = 0.003). It is possible that SCLOW females were unwilling to tolerate the same perceptual intensity of AH as the SCHIGH females. CONCLUSIONS These results indicate that individuals high in trait self-control are more tolerant of dyspnoea during a CO2 rebreathing challenge than low self-control individuals. Tolerance of the stimulus was moderated by the sex of the participant, presenting an interesting opportunity for future research.
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Affiliation(s)
- J C Brown
- Department of Sport Science, Clifton Campus, Nottingham Trent University, Nottingham, United Kingdom.
| | - R Boat
- Department of Sport Science, Clifton Campus, Nottingham Trent University, Nottingham, United Kingdom
| | - N C Williams
- Department of Sport Science, Clifton Campus, Nottingham Trent University, Nottingham, United Kingdom
| | - M A Johnson
- Department of Sport Science, Clifton Campus, Nottingham Trent University, Nottingham, United Kingdom
| | - G R Sharpe
- Department of Sport Science, Clifton Campus, Nottingham Trent University, Nottingham, United Kingdom
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Ide-Walters C, Thompson T. A Sham-Controlled Study of Neurofeedback for Pain Management. Front Neurosci 2021; 15:591006. [PMID: 34381326 PMCID: PMC8350778 DOI: 10.3389/fnins.2021.591006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 06/25/2021] [Indexed: 11/26/2022] Open
Abstract
Background Neurofeedback (NFB) attempts to alter the brain’s electrophysiological activity and has shown potential as a pain management technique. Existing studies, however, often lack appropriate control groups or fail to assess whether electrophysiological activity has been successfully regulated. The current study is a randomized controlled trial comparing changes in brain activity and pain during NFB with those of a sham-control group. Methods An experimental pain paradigm in healthy participants was used to provide optimal control of pain sensation. Twenty four healthy participants were blind randomized to receive either 10 × NFB (with real EEG feedback) or 10 × sham (with false EEG feedback) sessions during noxious cold stimulation. Prior to actual NFB training, training protocols were individually determined for each participant based on a comparison of an initial 32-channel qEEG assessment administered at both baseline and during an experimental pain task. Each individual protocol was based on the electrode site and frequency band that showed the greatest change in amplitude during pain, with alpha or theta up-regulation at various electrode sites (especially Pz) the most common protocols chosen. During the NFB sessions themselves, pain was assessed at multiple times during each session on a 0–10 rating scale, and ANOVA was used to examine changes in pain ratings and EEG amplitude both across and during sessions for both NFB and sham groups. Results For pain, ANOVA trend analysis found a significant general linear decrease in pain across the 10 sessions (p = 0.015). However, no significant main or interaction effects of group were observed suggesting decreases in pain occurred independently of NFB. For EEG, there was a significant During Session X Group interaction (p = 0.004), which indicated that EEG amplitude at the training site was significantly closer to the target amplitude for the NFB compared to the sham group during painful stimulation, but this was only the case at the beginning of the cold task. Conclusion While these results must be interpreted within the context of an experimental pain model, they underline the importance of including an appropriate comparison group to avoid attributing naturally occurring changes to therapeutic effects.
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Affiliation(s)
- Charlotte Ide-Walters
- Centre for Chronic Illness and Ageing, University of Greenwich, London, United Kingdom.,Cancer Research UK, London, United Kingdom
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, United Kingdom
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Abstract
BACKGROUND Pain is a complex and highly subjective phenomenon that can be modulated by several factors. On the basis of results from experimental and clinical studies, the existence of endogenous pain modulatory mechanisms that can increase or diminish the experience of pain is now accepted. METHODS In this narrative review, the pain modulatory effects of exercise, stress, and cognitions in humans are assessed. RESULTS Experimental studies on the effect of exercise have revealed that pain-free participants show a hypoalgesic response after exercise. However, in some patients with chronic pain, this response is reduced or even hyperalgesic in nature. These findings will be discussed from a mechanistic point of view. Stress is another modulator of the pain experience. Although acute stress may induce hypoalgesia, ongoing clinical stress has detrimental effects on pain in many patients with chronic pain conditions, which have implications for the understanding, assessment, and treatment of stress in patients with pain. Finally, cognitive strategies play differing roles in pain inhibition. Two intuitive strategies, thought suppression and focused distraction, will be reviewed as regards experimental, acute, and chronic pain. CONCLUSION On the basis of current knowledge on the role of exercise, stress, and cognitive pain control strategies on the modulation of pain, implications for treatment will be discussed.
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Inter-individual predictors of pain inhibition during performance of a competing cognitive task. Sci Rep 2020; 10:21785. [PMID: 33311585 PMCID: PMC7732830 DOI: 10.1038/s41598-020-78653-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 11/24/2020] [Indexed: 11/08/2022] Open
Abstract
The main function of pain is to automatically draw attention towards sources of potential injury. However, pain sometimes needs to be inhibited in order to address or pursue more relevant tasks. Elucidating the factors that influence how people manage this relationship between pain and task performance is essential to understanding the disruptive nature of pain and its variability between individuals. Here, 41 healthy adults completed a challenging working memory task (2-back task) while receiving painful thermal stimulations. Examining the trial-by-trial relationship between pain perception and task performance revealed that pain's disruptive effects on performance were mediated by self-reported pain intensity, and that the analgesic effects of a competing task were influenced by task performance. We found that higher pain catastrophizing, higher trait anxiety, and lower trait mindfulness were associated with larger trade-offs between pain perception and task performance, suggesting that these psychological factors can predict increased fluctuations between disruption by pain and analgesia from a competing task. Altogether these findings provide an important and novel perspective on our understanding of individual differences in the interplay between pain and ongoing task performance.
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Chayadi E, McConnell BL. Gaining insights on the influence of attention, anxiety, and anticipation on pain perception. J Pain Res 2019; 12:851-864. [PMID: 30881096 PMCID: PMC6402711 DOI: 10.2147/jpr.s176889] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose This article highlights the influence of attention and pain anticipation on pain attenuation. Pain-related trait anxiety was found to moderate the effect that attention strategies impose on pain perception. This article may contribute to clinical treatments quality, where pain attenuation effect is desired. Participants and methods One hundred seven participants, comprising of 72 (67%) females and 35 (33%) males between the age of 17 and 48 (M=22.6, SD =4.36), were used in the analysis. The current study measured the effect of pain anticipation and attention on three aspects of pain perception: threshold, tolerance, and perceived pain intensity. Pain anticipation was manipulated by varying the amount of information given to participants about a future pain stimulus. Attention was manipulated through a sensory focusing task and a distraction task. Participants were randomized into 1) InfoControl group with distraction task trial (n=30), 2) InfoControl group with attention to pain trial (n=26), 3) InfoExtra group with distraction task trial (n=26), or 4) InfoExtra group with attention to pain trial (n=25). The pain stimulus was delivered in a form of heat. The moderating effects of pain-related trait anxiety on these variables were also investigated using Pain Anxiety Symptom Scale Short Form. Results Two structural equation models revealed that anticipation is not a predictor of pain perception and neither did it interact with pain-related trait anxiety. However, attention strategies do significantly relate to pain perception. Furthermore, pain-related anxiety was a significant moderator of attention and pain attenuation. These findings imply that the effectiveness of attention strategies in attenuating pain is affected by individuals’ pain-related trait anxiety. Conclusion The results suggest the importance of appointing the appropriate attention strategy to different individuals with varying level of trait anxiety. Future explorations are necessary to develop a more specific understanding on the nature of information and distractions on pain perception.
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Van Ryckeghem DM, Van Damme S, Eccleston C, Crombez G. The efficacy of attentional distraction and sensory monitoring in chronic pain patients: A meta-analysis. Clin Psychol Rev 2017; 59:16-29. [PMID: 29126746 DOI: 10.1016/j.cpr.2017.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/02/2017] [Accepted: 10/24/2017] [Indexed: 01/06/2023]
Abstract
Attentional strategies, such as distraction and sensory monitoring, are often offered to reduce pain and pain-related distress. However, evidence for their efficacy in chronic pain patients is equivocal. We report a meta-analysis on the efficacy of distraction and sensory monitoring in chronic pain patients, and explore possible methodological and theoretical moderators. The scientific literature was searched for relevant articles, which were coded for methodological quality and several theoretical and methodological moderator variables. Only 10 articles fulfilled the search criteria. Eight studies allowed us to compare distraction with a control condition, two studies to compare sensory monitoring with a control condition, and four studies to compare the effect of distraction with the effect of sensory monitoring. Overall, results indicate that distraction did not differ from control in altering pain experience (k=8; Hedges' g=0.10, ns) and distress (k=2; Hedges' g=0.549). Sensory monitoring did also not alter pain experience (k=2; Hedges' g=-0.21, ns) and distress (k=1; Hedges' g=-0.191, ns). We found no evidence to support the superiority of distraction or sensory monitoring in altering pain compared to control conditions. We offer guidance for future theory-driven research to investigate distraction and sensory monitoring in this largely unexplored field, albeit one replete with methodological difficulties.
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Affiliation(s)
- Dimitri Ml Van Ryckeghem
- Institute for Health and Behaviour, INSIDE, University of Luxembourg, Luxembourg; Department of Experimental Clinical and Health Psychology, Ghent University, Belgium.
| | - Stefaan Van Damme
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Christopher Eccleston
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium; Centre for Pain Research, University of Bath, UK
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium; Centre for Pain Research, University of Bath, UK
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Thompson T, Oram C, Correll CU, Tsermentseli S, Stubbs B. Analgesic Effects of Alcohol: A Systematic Review and Meta-Analysis of Controlled Experimental Studies in Healthy Participants. THE JOURNAL OF PAIN 2017; 18:499-510. [PMID: 27919773 DOI: 10.1016/j.jpain.2016.11.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/02/2016] [Accepted: 11/14/2016] [Indexed: 11/20/2022]
Abstract
Despite the long-standing belief in the analgesic properties of alcohol, experimental studies have produced mixed results. This meta-analysis aimed to clarify whether alcohol produces a decrease in experimentally-induced pain and to determine the magnitude of any such effect. PubMed, PsycINFO, and Embase databases were searched from inception until April 21, 2016 for controlled studies examining the effect of quantified dosages of alcohol on pain response to noxious stimulation. Eighteen studies involving 404 participants were identified providing alcohol versus no-alcohol comparisons for 13 tests of pain threshold (n = 212) and 9 tests of pain intensity ratings (n = 192). Random effects meta-analysis of standardized mean difference (SMD) provided robust support for analgesic effects of alcohol. A mean blood alcohol content (BAC) of approximately .08% (3-4 standard drinks) produced a small elevation of pain threshold (SMD [95% CI] = .35 [.17-.54], P = .002), and a moderate to large reduction in pain intensity ratings (SMD [95% CI] = .64 [.37-.91], P < .0001), or equivalently, a mean reduction of 1.25 points on a 0- to 10-point pain rating scale. Furthermore, increasing BAC resulted in increasing analgesia, with each .02% BAC increment producing an increase of SMD = .11 for pain threshold and SMD = .20 for reduced pain intensity. Some evidence of publication bias emerged, but statistical correction methods suggested minimal impact on effect size. Taken together, findings suggest that alcohol is an effective analgesic that delivers clinically-relevant reductions in ratings of pain intensity, which could explain alcohol misuse in those with persistent pain despite its potential consequences for long-term health. Further research is needed to corroborate these findings for clinical pain states. PERSPECTIVE This meta-analysis provides robust evidence for the analgesic properties of alcohol, which could potentially contribute to alcohol misuse in pain patients. Strongest analgesia occurs for alcohol levels exceeding World Health Organization guidelines for low-risk drinking and suggests raising awareness of alternative, less harmful pain interventions to vulnerable patients may be beneficial.
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Affiliation(s)
- Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, United Kingdom.
| | - Charlotte Oram
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - Christoph U Correll
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York; Hofstra Northwell School of Medicine, Hempstead, New York
| | - Stella Tsermentseli
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Roberts MH, Klatzkin RR, Mechlin B. Social Support Attenuates Physiological Stress Responses and Experimental Pain Sensitivity to Cold Pressor Pain. Ann Behav Med 2016; 49:557-69. [PMID: 25623896 DOI: 10.1007/s12160-015-9686-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Social support improves health and has been shown to attenuate stress and pain. The precise characteristics of social support responsible for these effects, however, remain elusive. PURPOSE The purpose of this study is to examine the relative efficacy of social support versus a neutral non-verbal social presence to attenuate stress and pain. METHODS Seventy-six participants provided pain ratings and task assessments during a cold pressor task (CPT) in one of three conditions: verbal social support, neutral non-support, or alone. Reactivity to the CPT was assessed via cardiovascular measures, cortisol, and subjective ratings. RESULTS Participants receiving social support showed attenuated blood pressure, heart rate, and cortisol reactivity, as well as reduced pain ratings, task difficulty, tension, and effort compared to neutral non-support and alone conditions. CONCLUSIONS Social support, not the mere presence of another individual, attenuated stress and pain during a CPT. Given the negative health consequences of stress and pain, clinical studies incorporating social support into medical procedures and treatments are warranted.
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Affiliation(s)
- Matthew H Roberts
- Department of Psychology, Rhodes College, 2000 North Parkway, Memphis, TN, 38112, USA
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Coulombe MA, Erpelding N, Kucyi A, Davis KD. Intrinsic functional connectivity of periaqueductal gray subregions in humans. Hum Brain Mapp 2016; 37:1514-30. [PMID: 26821847 DOI: 10.1002/hbm.23117] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 12/08/2015] [Accepted: 01/03/2016] [Indexed: 12/19/2022] Open
Abstract
The periaqueductal gray matter (PAG) is a key brain region of the descending pain modulation pathway. It is also involved in cardiovascular functions, anxiety, and fear; however, little is known about PAG subdivisions in humans. The aims of this study were to use resting-state fMRI-based functional connectivity (FC) to parcellate the human PAG and to determine FC of its subregions. To do this, we acquired resting-state fMRI scans from 79 healthy subjects and (1) used a data-driven method to parcellate the PAG, (2) used predefined seeds in PAG subregions to evaluate PAG FC to the whole brain, and (3) examined sex differences in PAG FC. We found that clustering of the left and right PAG yielded similar patterns of caudal, middle, and rostral subdivisions in the coronal plane, and dorsal and ventral subdivisions in the sagittal plane. FC analysis of predefined subregions revealed that the ventolateral(VL)-PAG was supfunctionally connected to brain regions associated with descending pain modulation (anterior cingulate cortex (ACC), upper pons/medulla), whereas the lateral (L) and dorsolateral (DL) subregions were connected with brain regions implicated in executive functions (prefrontal cortex, striatum, hippocampus). We also found sex differences in FC including areas implicated in pain, salience, and analgesia including the ACC and the insula in women, and the MCC, parahippocampal gyrus, and the temporal pole in men. The organization of the human PAG thus provides a framework to understand the circuitry underlying the broad range of responses to pain and its modulation in men and women.
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Affiliation(s)
- Marie-Andree Coulombe
- Division of Brain, Imaging & Behaviour Systems, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Nathalie Erpelding
- Division of Brain, Imaging & Behaviour Systems, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Aaron Kucyi
- Division of Brain, Imaging & Behaviour Systems, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Karen Deborah Davis
- Division of Brain, Imaging & Behaviour Systems, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
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14
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Liu B, Xu H, Guo S, Wu J, Liu J, Lim MY, Liu Z. Prevalence and Correlates of Discomfort and Acceptability of Acupuncture among Outpatients in Chinese Acupuncture and Moxibustion Departments: A Cross-Sectional Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:715480. [PMID: 23864895 PMCID: PMC3707286 DOI: 10.1155/2013/715480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 04/16/2013] [Accepted: 05/08/2013] [Indexed: 11/17/2022]
Abstract
Objective. This study aims to give a profile of discomfort and acceptability of acupuncture, including the prevalence and association with demographic and acupuncture-related factors. Methods. A cross-sectional study was conducted in Beijing, China. Outpatients of acupuncture and moxibustion departments were recruited using purposive sampling. 925 subjects were interviewed with an anonymous questionnaire. Multinomial and binary logistic regression were used to analyze factors affecting discomfort and acceptability of acupuncture. Results. The average VAS value of 925 subjects' acupuncture discomfort was 2.66 ± 2.02, within the range of mild discomfort. Acupuncture was easily accepted by 81.1% of the subjects. Results of logistic regression were as follows: (1) subjects with a better knowledge of acupuncture, or a greater fear of pain or needles, experienced more "moderate to severe discomfort" and showed a decreased acupuncture acceptance (P < 0.001 or P < 0.01); (2) Acupuncture with less discomfort or implemented by a more qualified doctor was easy to be accepted (P < 0.001); (3) subjects aged 20-29 preferred to report "moderate to severe discomfort" while those aged 40-59 preferred to report "slight discomfort" (P < 0.001). Conclusion. Acupuncture is an acceptable therapy with less discomfort, which can be greatly affected by fear of pain or needles, age, knowledge of acupuncture, and professional title of acupuncturist.
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Affiliation(s)
- Baoyan Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Huanfang Xu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Shengnan Guo
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Jiani Wu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Jia Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Min Yee Lim
- Beijing University of Chinese Medicine, Beijing 100029, China
- China & Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798
| | - Zhishun Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
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15
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The effects of coping style on virtual reality enhanced videogame distraction in children undergoing cold pressor pain. J Behav Med 2012. [DOI: 10.1007/s10865-012-9479-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Thompson T, Keogh E, Chen MJL, French CC. Emotion-focused coping and distraction: Sex differences in the influence of anxiety sensitivity during noxious heat stimulation. Eur J Pain 2011; 16:410-20. [DOI: 10.1002/j.1532-2149.2011.00028.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2011] [Indexed: 11/09/2022]
Affiliation(s)
| | - E. Keogh
- Centre for Pain Research & Department of Psychology; University of Bath; Bath; BA2 7AY; UK
| | | | - C. C. French
- Department of Psychology, Goldsmiths; University of London; London; SE14 6NW; UK
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